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Application Number: WEB-20231 <br /> DANE COUNTY ZONING PERMIT ZONING PERMIT NO. <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JOHN J HENSEY 608-845-8577 JOHN J HENSEY 608-845-8577 <br /> BILLING ADDRESS (Number.Street) ADDRESS (Number,Street) <br /> 2550 WHITE CROSSING RD 2550 WHITE CROSSING RD <br /> (City,State,Zip) (City,State,Zip) <br /> VERONA, WI 53593 VERONA, WI 53593 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> JJKVLOYAHOO.COM JJKVL YAHOO.COM <br /> PA..r:CEL riC. TOWNSHIP 1/4 1/4 1/4 <br /> SECTION <br /> 0607-134-8110-4 SPRINGDALE 13 SE NE <br /> • - • • : ..vvRCSS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignmentof new address is subject <br /> 5 WHITE CROSSING RD <br /> to field ve cation.) <br /> I LOT BLOCK C.S.M.NO or PLAT NAME <br /> 1 CSM 03343 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: J New Addition/Alteration CENSUS CODE <br /> Description;;21 FOOT CIRCULAR ABOVE GROUND POOL WITH <br /> !CATEGORY g Residential J Commercial JAgricultural SEWER SANITARY PERMIT NO. <br /> J Other: <br /> Public Li Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P NO. VARIANCE NO. DEED RESTRICTION <br /> 0Yes ❑No <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO, <br /> Yes 3 No U Yes 3 No D Yes Li No <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 4.5 Sq.Ft. Sq.Ft. PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $ 2,000.00 <br /> PERMIT FEE <br /> <1 Sq.Ft. Sq.Ft. $ <br /> 1. I,the undersigned,hereby make application for a zoning permit only for the location and the work described herein and certify to the accuracy of that <br /> information. I further certify I am the owner of the property,or a duly authorized representative,and may sign this permit application on behalf of the <br /> owner(s) of said property, and I have read and understand all of the conditions of this permit and will construct the project in compliance with <br /> those conditions. I understand that failure to comply with any provision of the permit renders it null and void and may result in an enforcement action. <br /> 2. I,the undersigned,hereby certify that: <br /> • I have made a diligent inquiry into the applicability of any official map to the applicants'land; <br /> • No such official map is applicable,or,if such map is applicable,the approval of the appropriate city or village has been obtained; <br /> • I have not relied upon any statements of County employees in giving these assurances; <br /> • I understand the possible adverse consequences of erecting any structure within an officially mapped area without the proper approval of the city or <br /> village involved.Any zoning permit issued for a property located within an official mapped area for which the applicant has not obtained the proper <br /> permit from the appropriate village or city shall be null and void. <br /> 3. I, the undersigned, hereby consent to the entry on the permitted premises by zoning inspectors of the Dane County Department of Planning & <br /> Development to determine compliance with the county's zoning ordinances. This consent is valid for the period commencing with issuance of this <br /> zoning permit and terminating with issuance of a certificate of compliance or until earlier revoked in writing by the owner of the property. <br /> I Owner&Agent hereby agree to comply with all Dane County SIGNATURE;: Owner/Agent DATE: <br /> Ordinances.Any unauthorized change from the information <br /> or plans submitted will invalidate the permit. <br /> OFFICE USE ONLY <br /> SURVEY REQUIRED? DATE ISSUED INI IAL S 1st INSPECTION DATE- INITIALS <br /> ©Yes Q No <br /> DATE REVIEWED INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: <br /> Conditions: <br /> 545-112(12!05) WEB <br />